Acute Lung Injury (ALl) is relatively common and associated with significant short-term mortality and long-term morbidity. Despite evidence that a lung-protective conventional ventilator approach (CVLP) is associated with reduced 28 day mortality, it is unknown how widely CVLP is used, and we have a poor understanding of the barriers to its use. Moreover, little is known regarding the long-term mortality and outcomes in ALl patients or whether CVLP improves these long-term outcomes. To improve outcomes for patients with ALl, we must understand the barriers to compliance with CVLP, long-term mortality and other outcomes associated with ALl, and the constellation of factors and other therapies that may be associated with those outcomes. This study will add important new knowledge to our understanding of ways to improve the care of patients with ALl. We propose to evaluate the following 2 specific aims: 1a. To evaluate the use of CVLP as a care strategy in a cohort of patients with ALl. 1b. To identify patient, provider and organizational barriers to using CVLP. 2. To evaluate the association between CVLP ventilation and other aspects of care with long-term mortality in patients with ALl. We will also evaluate a secondary aim: to evaluate the association between CVLP and other aspects of care with a broad group of patient outcomes. To evaluate the aims, we will conduct a cohort study at 4 hospitals--6 intensive care units (ICUs)--in the Baltimore metropolitan area. We will evaluate exposure to specific medical therapies: use of CVLP, paralysis, steroids, antibiotics and nutrition; and timing of tracheotomy during patient ICU stay. Outcome variables are: discharge, 6 month, one year and 2 year mortality; and disorders of biologic functioning, clinical events and patient reported outcomes. We will evaluate outcomes in the General Clinical Research Center at discharge, 1 year and 2 years after diagnosis of ALl. We will evaluate outcomes at 6 months with phone survey. This study is significant as it adds new knowledge about barriers to using CVLP strategies, long-term outcomes of patients with ALl and the impact of CVLP on these outcomes. Moreover, by identifying medical therapies in addition to CVLP that are associated with these outcomes; we will identify opportunities to improve care of patients with ALl. Aspects of this project represent collaborative efforts with other projects and cores on this SCCOR focused on ventilator associated lung injury.